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Tiotropium bromide is an orally inhaled medication used to treat symptoms of chronic obstructive pulmonary disease (COPD). A nonreversible lung disease, COPD is a blend of chronic bronchitis and emphysema in which the lungs make too much mucus. This causes a deep, frequent cough as the body tries to expel the mucus.
Tiotropium bromide is an anticholinergic bronchodilator. This means it blocks a neurotransmitter called acetylcholine, relaxing — or dilating — muscles in the bronchi, the two tubes between the lungs and the trachea. This helps reduce coughing, shortness of breath, and other symptoms of COPD.
Tiotropium bromide, sold in 2010 under the brand name Spiriva®, must be prescribed by a doctor; it comes in a capsule that is put into a HandiHaler®, where it is pierced and releases a powder. The patient then immediately inhales twice through the HandiHaler® mouthpiece. This is usually done only once every 24 hours, although a doctor may prescribe it to be taken more often. The capsule must be taken from its packaging immediately before using it; otherwise, it loses its effectiveness. It must not be used more often than prescribed, and it is not meant as an emergency medication like some asthma inhalers.
Patients are cautioned not to allow the tiotropium bromide powder to get in their eyes, because it will irritate them and cause the pupils to dilate and vision to blur. Even if the powder has not gotten into the eye, vision problems may arise as a side effect of the medication. If the patient experiences any vision changes or eye pain, he should contact his doctor.
Other side effects of the medication include hive-like rashes and swellings in a variety of locations on the body. A very serious side effect is that it can worsen, rather than relieve, coughing and wheezing. This can be life-threatening, so a physician should be notified immediately if this occurs. There also is a long list of possible side effects that are common and annoying, but not serious. Many times, these subside as the patient's body becomes accustomed to the medication.
In October 2008, the U.S. Food and Drug Administration (FDA) indicated that it was watching for signs of an increased risk of heart attack, stroke or death as a side effect of tiotropium bromide. This came after several studies suggested the possibility. In January 2010, however, the FDA stated that a careful review had shown them no association of these side effects with Spiriva® use.
Nonetheless, users of the product must be careful to follow the direction of their physician and to notify the physician at the first sign of a potentially serious side effect. Patients are also warned not to take any over-the-counter medication without approval from the doctor. This includes vitamins and herbal supplements.